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Leeches are blood-sucking parasites which are generally found inpuddles of water and streams. They have two suckers. The posterior sucker ismainly used for leverage while the anterior, consisting of the jaw and teeth,is where the feeding takes place. Leeches can ingest an amount of bloodapproaching 10 times their own weight and may not require feeding for up to oneyear after their last meal.
The contamination occurs by drinking or swimming in infected water,and then, leeches localize on the mucus of the upper respiratory tract, esophagus,lower genitourinary tract (urethra and vagina) , rarely in the lower respiratorytract and even eyes. Leeches can reach the lower airway when water is ingesteddirectly from an infected lake or river. The localization of the leech in thetrachea causes symptoms like hemoptysis, hoarseness and respiratory distress. Thetracheal leech infestation is a relatively rare cause of hemoptysis. Thediagnosis should be considered in the presence of unexplained hemoptysis, inpatients with a recent history of drinking unboiled stream water. Bronchoscopyis the key examination to confirm the diagnosis.
The extraction of the leech attached to the respiratory tract is notalways easy , firstly because of its slippery body surface which can easily beruptured, on the other hand due to its important link power. A case reportdescribed a 15-year-old female from Iran in whom the leech infestation was locatedin the right lower lobe anteromedial bronchus. While trying to remove the wormby forceps, it ruptured and the leech’s sucker remained attached to thebronchial mucosa. The remaining worm particle was removed by using a Dormiabasket. In addition, a case was a 40-year-old woman from China with trachealleech infestation. The doctors performed bronchoscopy under lidocaine topicalanesthesia, and intended to remove it by using forceps , but failed to extractit. Eventually, the leech was removed by rigid bronchoscopy under generalanesthesia.
Cryotherapy, which is the therapeutic application of extreme coldfor local destruction of living tissue, has been shown to be effective and safein treating endobronchial lesions. As early as 1989, Roden S and Homasson J Pfirst reported the successful removal of foreign bodies via intrabronchialcryotherapy by rigid bronchoscopy. In our case, leech was removed safely in onepiece by using intrabronchial cryotherapy with the requirement of localanesthesia. Cryotherapy can make the leech’s sucker lost adhesion, and make iteasier to extract.
In conclusion, the physician should be aware of the possibility ofthe tracheobronchial leeches if the patients have a history of drinking fieldunboiled water and have the following symptoms, such as hemoptysis, cough,throat discomfort. Intrabronchial cryotherapy by bronchoscope might be the bestway of extraction of leeches.
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